What are the lessons learned from this week's White House health care summit, and how should reform efforts proceed from here?

House Minority Leader John Boehner, R-Ohio, said: "The thing I have heard more than anything over the last six or seven months is that the American people want us to scrap this bill. They have said it loud. They have said it clear."

House Ways and Means Chairman Charles Rangel, D-N.Y., said: "We entered this room with the understanding that we agree on 70 percent of what is in the health reform bill. If that is the case, I simply cannot understand the repeated calls by my Republican colleagues to scrap the bill and start anew. That type of rhetoric means you've made up your mind that we're not going to have a health reform bill. And I don't think that's consistent with what the American people sent us to Congress to do."

What is the best course of action at this point, and was the summit at all worthwhile?

15 Responses

March 4, 2010 10:21 AM

Too Little, Too Late

President Obama's four concessions to Republicans outlined in his 35th speech on health care on March 3rd, like his last gasp concession to open discussion of the issue, are of no value, way too little and far too late, All of his ideas will result in higher taxes for all Americans and will not reduce costs or lower the uninsured number. The real problem is the fact that the Democratic members of the House and Senate cannot agree on the content of the bills, from subsidies, mandates, new taxes, new bureaucracies and controls on insurance companies including a new Health Insurance Rate Authority. The Republicans and the American people would like to see the current bills scrapped and a new plan developed. The latest CNN poll shows that only 25 percent of Americans like the President's plan.

President Obama is fond of quoting the false comparison of Republican incremental approaches to his comprehensive solution, yet his plan--he finally came up with one by cutting and pasting from the House and Senate bills--leaves millions receiving care in the supposedly awful saf...

President Obama's four concessions to Republicans outlined in his 35th speech on health care on March 3rd, like his last gasp concession to open discussion of the issue, are of no value, way too little and far too late, All of his ideas will result in higher taxes for all Americans and will not reduce costs or lower the uninsured number. The real problem is the fact that the Democratic members of the House and Senate cannot agree on the content of the bills, from subsidies, mandates, new taxes, new bureaucracies and controls on insurance companies including a new Health Insurance Rate Authority. The Republicans and the American people would like to see the current bills scrapped and a new plan developed. The latest CNN poll shows that only 25 percent of Americans like the President's plan.

President Obama is fond of quoting the false comparison of Republican incremental approaches to his comprehensive solution, yet his plan--he finally came up with one by cutting and pasting from the House and Senate bills--leaves millions receiving care in the supposedly awful safety net, even as unattainable promises are made about reducing out of pocket premium expenses and the federal deficit. Like the additional funds of $50 million for state demonstration projects on medical malpractice reform, this is a drop in the bucket. PriceWaterhouse Coopers has project ed the annual cost of defensive medicine at $210 billion.

It does not seem to me that House Speaker Pelosi has the 217 votes to pass the Senate bill before proceeding with votes on "fixes" and reconciliation. But, in politics, one can never be sure what goes on behind the scenes.

Americans know that they do not want the federal government in charge of their health care system nor do they want to pay higher taxes.

March 3, 2010 3:40 PM

An American Nightmare

The key health reform issue for Americans relates to medical underwriting and guaranteed issue. In this country, it is possible for someone who has dutifully maintained their insurance coverage for 30 years to contract a lengthy illness, lose their job, exhaust COBRA and find themselves unable to obtain affordable coverage. People want to be insured against this “nightmare” scenario, which could happen to any one of us.

Several states have simply required insurers to guarantee issue of coverage. As we’ve seen, this resulted in increased premiums by including higher-cost people, causing others to discontinue their coverage. Expanding existing high-risk pools could help, but the premiums can be greater than COBRA coverage, which we know is already too high for most of the uninsured.

Universal coverage is the only option on the table right now that can protect against the nightmare scenario. Requiring everyone to have coverage adds 20 million people to the individual market (14 million currently), which spreads risk across a broad risk p...

The key health reform issue for Americans relates to medical underwriting and guaranteed issue. In this country, it is possible for someone who has dutifully maintained their insurance coverage for 30 years to contract a lengthy illness, lose their job, exhaust COBRA and find themselves unable to obtain affordable coverage. People want to be insured against this “nightmare” scenario, which could happen to any one of us.

Several states have simply required insurers to guarantee issue of coverage.As we’ve seen, this resulted in increased premiums by including higher-cost people, causing others to discontinue their coverage. Expanding existing high-risk pools could help, but the premiums can be greater than COBRA coverage, which we know is already too high for most of the uninsured.

Universal coverage is the only option on the table right now that can protect against the nightmare scenario. Requiring everyone to have coverage adds 20 million people to the individual market (14 million currently), which spreads risk across a broad risk pool. This makes it possible to require guaranteed issue without creating a premium spiral. However, this requires subsidies for low-income people, leading to the spending and financing issues that now divide Congress.

Opponents of these bills need to explain how they would address the nightmare scenario. High risk pools alone won’t do the job because the premiums are prohibitive for most. One approach might be to create a separate supplemental insurance policy that employers and individuals could purchase to guard against the nightmare scenario. Tax credits for people in these predicaments could also address the problem.

But without something more, the House and Senate bills will be the only options in play that fully address the American nightmare scenario.

March 3, 2010 3:32 PM

GOP Ideas Should Get Up or Down Vote

I am encouraged by the President’s remarks this afternoon regarding the way forward on health insurance reform. Unfortunately, partisan politics and political gamesmanship have hijacked the health reform debate. Similar efforts have defeated prior efforts to reform health care and our nation is worse off for it. The scorch-and-burn tactics employed by opponents of reform have obscured the dangers the current system pose to American families, businesses, and our government. Americans are defenseless against selfish insurance companies and the skyrocketing cost of health care.

Health reform has been one of the most frequently debated issues during my time as a Member of Congress. We are closer than we have ever been before. The American people cannot afford to wait on us to act much longer. Both Houses of Congress passed health care reform bill last year. The Senate bill must be passed in the House in the coming weeks. However, we have to make necessary improvements to the Senate bill and incorporate ideals supported by my Republican colleagues. These improv...

I am encouraged by the President’s remarks this afternoon regarding the way forward on health insurance reform. Unfortunately, partisan politics and political gamesmanship have hijacked the health reform debate. Similar efforts have defeated prior efforts to reform health care and our nation is worse off for it. The scorch-and-burn tactics employed by opponents of reform have obscured the dangers the current system pose to American families, businesses, and our government. Americans are defenseless against selfish insurance companies and the skyrocketing cost of health care.

Health reform has been one of the most frequently debated issues during my time as a Member of Congress. We are closer than we have ever been before. The American people cannot afford to wait on us to act much longer. Both Houses of Congress passed health care reform bill last year. The Senate bill must be passed in the House in the coming weeks. However, we have to make necessary improvements to the Senate bill and incorporate ideals supported by my Republican colleagues. These improvements must receive an up-or-down vote.

When Republicans had control of the Senate, they vehemently argued for up-or-down votes on judicial nominations and have used reconciliation for tax cuts for the wealthy. I hope my Republican colleagues acknowledge the steps the President has genuinely taken to bridge the partisan divide that has plagued the process.

Why can’t we have a vote on this pressing question by a simple majority in the Senate? Why can’t we find agreement on the need for an up-or-down vote on a bill that will bring much needed relief for American families and businesses; a bill that will strengthen the Medicare program and set our country on a good fiscal track? This bill will lower premiums for millions of Americans while providing good care when individuals need it most.

I commend President Obama for his bold, decisive act today. It is one of the most politically courageous acts I have seen in my time in Congress. He has tied his Presidency to the success of this bill and history will look on him kindly for that.

March 3, 2010 11:56 AM

BetterMedicare Board Definitions Needed

As we reach the final stage of health system reform, the AMA is pleased that President Obama has offered some additional proposals, including expanding medical liability reforms, raising Medicaid payment rates to improve access to care for vulnerable patients and expanding the availability of health savings accounts.

AMA has consistently called for medical liability reforms to reduce the growth of health care costs. The independent Congressional Budget Office estimates that liability reform would reduce federal budget deficits by about $54 billion over the next 10 years.

The problems that are plaguing our health care system are very real, and they are hurting patients and physicians. The AMA is calling on Congress to pass common sense reforms that ensure patients have access to high-quality health care and affordable insurance coverage.

The AMA calls on President Obama and Congress to take additional action and correct outstanding problems with pending health system reform legislation. These issues include the need for a clear path to permanent reform ...

As we reach the final stage of health system reform, the AMA is pleased that President Obama has offered some additional proposals, including expanding medical liability reforms, raising Medicaid payment rates to improve access to care for vulnerable patients and expanding the availability of health savings accounts.

AMA has consistently called for medical liability reforms to reduce the growth of health care costs. The independent Congressional Budget Office estimates that liability reform would reduce federal budget deficits by about $54 billion over the next 10 years.

The problems that are plaguing our health care system are very real, and they are hurting patients and physicians. The AMA is calling on Congress to pass common sense reforms that ensure patients have access to high-quality health care and affordable insurance coverage.

The AMA calls on President Obama and Congress to take additional action and correct outstanding problems with pending health system reform legislation. These issues include the need for a clear path to permanent reform of the broken Medicare physician payment formula that hurts seniors’ access to care and a better definition of the scope and authority of an Independent Medicare Payment Advisory Board.

Let’s resolve these issues and get health system reform over the finish line for the American people.

March 3, 2010 10:58 AM

Lethal Injection, via Sterilized Needle

In a letter to congressional leaders, President Obama wrote of his openness to including Republican proposals in his health care legislation.

Dropping a few Republican ideas into a government takeover of health care is like sterilizing the needle before a lethal injection: a nice thought, but the ultimate outcome is the same.

Two of the four Republican ideas – federal grants to states that adopt medical malpractice liability reforms, and ratcheting upward Medicare’s physician-price controls – would increase government spending.
The president's health savings accounts (HSAs) proposal would merely loosen the noose around consumer-directed health plans.
Undercover investigations in Medicare and Medicaid are likely to be as unsuccessful ...

Dropping a few Republican ideas into a government takeover of health care is like sterilizing the needle before a lethal injection: a nice thought, but the ultimate outcome is the same.

Two of the four Republican ideas – federal grants to states that adopt medical malpractice liability reforms, and ratcheting upward Medicare’s physician-price controls – would increase government spending.

March 3, 2010 10:25 AM

Obama Considers 4 Republican Ideas

Are President Obama’s new concessions to Republicans of value? Is this enough? Too much?

Obama yesterday sent a letter to congressional leaders, indicating his support for including a handful of Republican ideas in health care reform legislation. He suggested building on waste, fraud and abuse initiatives already in his own proposal to include a suggestion from Sen. Tom Coburn, R-Okla., to have medical professionals conduct “random, undercover investigations of health care providers” that participate in government health care programs. He also said he was open to including $50 million to fund demonstration projects to test medical malpractice case alternatives, including health courts. HHS Secretary Kathleen Sebelius already has $23 million that she is preparing to hand out in grants for this purpose.

Obama also said that Congress should consider increasing reimbursements to physicians who participate in Medicaid, and offering high-deductible health plans in exchanges so that more people could take advantage of health savings accounts.

...

Are President Obama’s new concessions to Republicans of value? Is this enough? Too much?

Obama yesterday sent a letter to congressional leaders, indicating his support for including a handful of Republican ideas in health care reform legislation. He suggested building on waste, fraud and abuse initiatives already in his own proposal to include a suggestion from Sen. Tom Coburn, R-Okla., to have medical professionals conduct “random, undercover investigations of health care providers” that participate in government health care programs. He also said he was open to including $50 million to fund demonstration projects to test medical malpractice case alternatives, including health courts. HHS Secretary Kathleen Sebelius already has $23 million that she is preparing to hand out in grants for this purpose.

Obama also said that Congress should consider increasing reimbursements to physicians who participate in Medicaid, and offering high-deductible health plans in exchanges so that more people could take advantage of health savings accounts.

Thank you again for the time, energy, and preparation you invested in last Thursday’s bipartisan meeting on health insurance reform. I have always believed that our legislative process works best when both sides can discuss our differences and common goals openly and honestly, and I’m very pleased that our meeting at Blair House offered the American people and their elected representatives a rare opportunity to explore different health reform proposals in extraordinary depth.

The meeting was a good opportunity to move past the usual rhetoric and sound-bites that have come to characterize this debate and identify areas on which we agree and disagree. And one point on which everyone expressed agreement was that the cost of health care is a large and growing problem that, left untended, threatens families, businesses and the solvency of our government itself.

I also left convinced that the Republican and Democratic approaches to health care have more in common than most people think.

For example, we agree on the need to reform our insurance markets. We agree on the idea of allowing small businesses and individuals who lack insurance to join together to increase their purchasing power so they can enjoy greater choices and lower prices. And we agree on the dire need to wring out waste, fraud and abuse and get control of skyrocketing health care costs.

But there were also important areas of disagreement. There was a fundamental disagreement about what role the oversight of the health insurance industry should play in reform. I believe we must insist on some common-sense rules of the road to hold insurance companies accountable for the decisions they make to raise premiums and deny coverage. I don’t believe we can afford to leave life-and-death decisions about health care for America’s families to the discretion of insurance company executives alone.

No matter how we move forward, there are at least four policy priorities identified by Republican Members at the meeting that I am exploring. I said throughout this process that I’d continue to draw on the best ideas from both parties, and I’m open to these proposals in that spirit:

1. Although the proposal I released last week included a comprehensive set of initiatives to combat fraud, waste, and abuse, Senator Coburn had an interesting suggestion that we engage medical professionals to conduct random undercover investigations of health care providers that receive reimbursements from Medicare, Medicaid, and other Federal programs.

2. My proposal also included a provision from the Senate health reform bill that authorizes funding to states for demonstrations of alternatives to resolving medical malpractice disputes, including health courts. Last Thursday, we discussed the provision in the bills cosponsored by Senators Coburn and Burr and Representatives Ryan and Nunes (S. 1099) that provides a similar program of grants to states for demonstration projects. Senator Enzi offered a similar proposal in a health insurance reform bill he sponsored in the last Congress. As we discussed, my Administration is already moving forward in funding demonstration projects through the Department of Health and Human Services, and Secretary Sebelius will be awarding $23 million for these grants in the near future. However, in order to advance our shared interest in incentivizing states to explore what works in this arena, I am open to including an appropriation of $50 million in my proposal for additional grants. Currently there is only an authorization, which does not guarantee that the grants will be funded.

3. At the meeting, Senator Grassley raised a concern, shared by many Democrats, that Medicaid reimbursements to doctors are inadequate in many states, and that if Medicaid is expanded to cover more people, we should consider increasing doctor reimbursement. I’m open to exploring ways to address this issue in a fiscally responsible manner.

4. Senator Barrasso raised a suggestion that we expand Health Savings Accounts (HSAs). I know many Republicans believe that HSAs, when used in conjunction with high-deductible health plans, are a good vehicle to encourage more cost-consciousness in consumers’ use of health care services. I believe that high-deductible health plans could be offered in the exchange under my proposal, and I’m open to including language to ensure that is clear. This could help to encourage more people to take advantage of HSAs.

There are provisions that were added to the legislation that shouldn’t have been. That’s why my proposal does not include the Medicare Advantage provision, mentioned by Senator McCain at the meeting, which provided transitional extra benefits for Florida and other states. My proposal eliminates those payments, gradually reducing Medicare Advantage payments across the country relative to fee-for service Medicare in an equitable fashion (page 8). My proposal rewards high-quality and high-performing plans.

In addition, my proposal eliminates the Nebraska FMAP provision, replacing it with additional federal financing to all states for the expansion of Medicaid.

Admittedly, there are areas on which Republicans and Democrats don’t agree. While we all believe that reform must be built around our existing private health insurance system, I believe that we must hold the insurance industry to clear rules, so they can’t arbitrarily raise rates or reduce or eliminate coverage. That must be a part of any serious reform to make it work for the many Americans who have insurance coverage today, as well as those who don’t.

I also believe that piecemeal reform is not the best way to effectively reduce premiums, end the exclusion of people with pre-existing conditions or offer Americans the security of knowing that they will never lose coverage, even if they lose or change jobs.

My ideas have been informed by discussions with Republicans and Democrats, doctors and nurses, health care experts, and everyday Americans – not just last Thursday, but over the course of a yearlong dialogue. Both parties agree that the health care status quo is unsustainable. And both should agree that it’s just not an option to walk away from the millions of American families and business owners counting on reform.

After decades of trying, we’re closer than we’ve ever been to making health insurance reform a reality. I look forward to working with you to complete what would be a truly historic achievement.

March 2, 2010 4:01 PM

Time to Act

The White House's "Health Care Summit" on February 25 identified many areas of common cause between President Obama and members of Congress. They agreed broadly on the goals for reform and on many specifics, but a fundamental divide remains over making coverage affordable for every American and finding a way to pay for it.

The President's proposed approach, as well as the comprehensive reform proposals passed by the House of Representatives and Senate, would provide affordable coverage for those who are uninsured and ensure that premiums and medical bills do not exceed an affordable share of income for those with coverage. By contrast, Republican leaders offer several small steps that would assist certain groups—including tax credits for small businesses, tax incentives for health savings accounts, and state high-risk pools—but fail to make a substantial change in the numbers of uninsured and those experiencing difficulties paying premiums and medical bills.

Given the lack of bipartisan consensus and opposition engendered in part b...

The White House's "Health Care Summit" on February 25 identified many areas of common cause between President Obama and members of Congress. They agreed broadly on the goals for reform and on many specifics, but a fundamental divide remains over making coverage affordable for every American and finding a way to pay for it.

The President's proposed approach, as well as the comprehensive reform proposals passed by the House of Representatives and Senate, would provide affordable coverage for those who are uninsured and ensure that premiums and medical bills do not exceed an affordable share of income for those with coverage. By contrast, Republican leaders offer several small steps that would assist certain groups—including tax credits for small businesses, tax incentives for health savings accounts, and state high-risk pools—but fail to make a substantial change in the numbers of uninsured and those experiencing difficulties paying premiums and medical bills.

Given the lack of bipartisan consensus and opposition engendered in part by those who resist the changes proposed, it might be tempting to put off health reform to another day. But the need for action is compelling for at least four reasons. First, things will get worse if we don’t act – we already have a health system under serious strain and the status quo is simply unsustainable. Second, health reform is vital to our long-term economic recovery and growth. Third, health reform is good for all of us – every one of us is currently at risk of losing our health insurance and/or sacrificing our savings to medical expenses. And finally, it is our moral responsibility to see that everyone who needs health care receives it. It is the mark of a decent, humane society to take care of each other—and the U.S. is the only industrialized nation that fails to do so.

Now is the time for the nation’s leaders to rise to the challenge. It’s not about the number of pages in the bill or the process of getting it done, it’s about making coverage affordable to every American. We cannot afford to fail, and we cannot let down those who struggle to get the care they need and pay the bills their illnesses and injuries have inflicted upon them. We are one nation, not Democratic or Republican, but fellow human beings who deserve a helping hand when most in need.

March 1, 2010 12:24 PM

Republicans say no, time to move forward

At the summit from Republicans, who refused to bring a unified health care plan to the summit because they don't believe in a comprehensive health care solution, we heard lots of talk on a few main themes.

Multiple Republican attendees, Senator Lamar Alexander chief among them, alleged that the Democratic health care plan would raise insurance costs for people. This is the same thing the insurance industry claimed in their widely-discredited report after the Senate Finance Committee passed their bill.

Alexander and other Republicans repeating the talking point are wrong. Ezra Klein fact-checks the issue:

Yes, the CBO found health-care reform would reduce premiums. The issue gets confused because it also found that access to subsidies would encourage people to buy more comprehensive insurance, which would mean that the value of their insurance would be higher after reform than before it. But that's not the same as insurance becoming more expensive: The fact that I could buy a nicer car after getting a better job suggests that cars are becoming pricier. The bottom line is that if you're comparing two plans that are exactly the same, costs go down after reform.

Democratic plans would lower costs and give better coverage, Republican plans would do the opposite. I hope we can put this false talking point to rest.

Next, almost every Republican speaker mentioned tort reform as a solution to the health care crisis. They couldn't be more wrong. Multiple studies and CBO scores have shown that tort reform would make only a small dent in health care costs, if at all.

Annual jury awards and legal settlements involving doctors amounts to “a drop in the bucket” in a country that spends $2.3 trillion annually on health care, Amitabh Chandra, another Harvard University economist, recently told Bloomberg News. Chandra estimated the cost of jury awards at about $12 per person in the U.S., or about $3.6 billion. Insurer WellPoint Inc. has also said that liability awards are not what’s driving premiums.

A study by Bloomberg also found that the proportion of medical malpractice verdicts among the top jury awards in the U.S. declined over the last 20 years. “Of the top 25 awards so far this year, only one was a malpractice case.” Moreover, at least 30 states now cap damages in medical lawsuits.

Another data point, Texas is a state that has passed harsh tort reform laws, and it still has some of the highest health care costs in the country:

The experience of Texas in capping damage awards is a good example. Contrary to Perry’s claims, a recent analysis by Atul Gawande in the New Yorker found that while Texas tort reforms led to a cap on pain-and-suffering awards at two hundred and fifty thousand dollars, which led to a dramatic decline in lawsuits, McAllen, Texas is one of the most expensive health care markets in the country. In 2006, “Medicare spent fifteen thousand dollars per person enrolled in McAllen, he finds, which is almost twice the national average — although the average town resident earns only $12,000 a year. “Medicare spends three thousand dollars more per person here than the average person earns.”

Tort reform isn't going to bring down costs. If Republicans are actually concerned about bringing down costs, they'll have to bring another idea to the table.

And a note on reconciliation. Republicans have tried all morning to paint reconciliation as some kind of out-of-the-ordinary, radical procedure. It's not. It's used regularly and it's been used to pass sweeping legislation before like Bush's tax cuts or Bill Clinton's welfare reform. And in fact, the Republicans at the summit have voted for these big programs using reconciliation in the past.

A careful analysis of the reconciliation process shows that it's perfectly suited for finishing health reform right and fixing the Senate bill. In fact, "the way in which virtually all of health reform, with very, very limited exceptions, has happened over the past 30 years has been the reconciliation process."

In addition, Republicans kept insisting that if only average Americans had more "skin in the game" when it came to health care costs, those costs would go down. In particular, they tout health savings accounts as a solution.

Health savings accounts by definition favor the wealthy and/or the healthy. For those that never go to the doctor, or who can afford the high out-of-pocket costs incurred when using health savings accounts (you need to pay $1,050 as an individual or $2,100 for a family before your insurance will cover the rest), health savings accounts are great. Wealthy and/or healthy individuals can put a bit of money away, tax free, into their health savings account and then draw from it to pay their astronomical out-of-pocket costs when they decide to go see a doctor. If you're healthy, the doctor's visit doesn't happen very often. If you're wealthy, who cares if it happens very often, you can afford it.

For the rest of us, however, health savings accounts don't work. If we get sick and see the doctor often, we have to pay those huge costs often; that means we have to save a lot of money in that health savings account. For those on fixed incomes, or even those just barely scraping by (and that's a lot of us in today's economic climate), putting away even $4,000 in a health savings account is out of the question. Health savings accounts don't work for the same reason tax credits don't work: Those who don't have a lot of cash to save are forced to put away money they don't have a bit at a time to pay for their care. With tax credits, they get repaid at the end of the year. With health savings accounts, they don't pay taxes on that money. But either way, they need to save over the course of a year to get that payoff. For a lot of folks, this just isn't a realistic option - there's simply nothing to spare.

As the President pointed out, Republicans might feel differently about health savings accounts if they made $40,000 per year instead of the hundreds of thousands they make as Members of Congress.

Another perpetual Republican talking point was the wonders that would occur if only we could buy insurance across state lines.

Insurance is currently regulated by states. California, for instance, says all insurers have to cover treatments for lead poisoning, while other states let insurers decide whether to cover lead poisoning, and leaves lead poisoning coverage — or its absence — as a surprise for customers who find that they have lead poisoning. Here's a list (pdf) of which states mandate which treatments.

The result of this is that an Alabama plan can't be sold in, say, Oregon, because the Alabama plan doesn't conform to Oregon's regulations. A lot of liberals want that to change: It makes more sense, they say, for insurance to be regulated by the federal government. That way the product is standard across all the states.

Conservatives want the opposite: They want insurers to be able to cluster in one state, follow that state's regulations and sell the product to everyone in the country. In practice, that means we will have a single national insurance standard. But that standard will be decided by South Dakota. Or, if South Dakota doesn't give the insurers the freedom they want, it'll be decided by Wyoming. Or whoever.

This is exactly what happened in the credit card industry, which is regulated in accordance with conservative wishes. In 1980, Bill Janklow, the governor of South Dakota, made a deal with Citibank: If Citibank would move its credit card business to South Dakota, the governor would literally let Citibank write South Dakota's credit card regulations. You can read Janklow's recollections of the pact here.

Citibank wrote an absurdly pro-credit card law, the legislature passed it, and soon all the credit card companies were heading to South Dakota. And that's exactly what would happen with health-care insurance. The industry would put its money into buying the legislature of a small, conservative, economically depressed state. The deal would be simple: Let us write the regulations and we'll bring thousands of jobs and lots of tax dollars to you. Someone will take it. The result will be an uncommonly tiny legislature in an uncommonly small state that answers to an uncommonly conservative electorate that will decide what insurance will look like for the rest of the nation.

It's a race to the bottom, selling our health to the lowest insurance company bidder. It's not a solution that makes us more healthy or lowers our cost - CBO said selling insurance across state lines wouldn't expand coverage at all and would only save $12 billion over 10 years, a fraction of what real health care reform would save.

Finally, Republicans continually made the point that the American public doesn't want health reform. As Nancy Pelosi said, there have been so many lies about the health care bills, it's a wonder anyone likes them. And it's important to stand up for popular things - like a public option - to make it better. But that doesn't mean the American people don't want reform.

The Republicans didn't bring a plan to the summit. Instead, they brought stale, easily-debunked talking points. They tried to prove that giving good health care to Americans was a bad idea, but they failed. And in the end, they resorted to the same slogans they've been repeating for a year now - start over, blank slate, incremental reform.

We've heard from the other side and found they have no plan to solve the greatest problem facing the nation. Now it's time to finish the job and finish it right.

March 1, 2010 9:59 AM

Real Problems are Being Ignored

President and CEO, National Center for Policy Analysis, and Kellye Wright Fellow

The difference between Republicans and Democrats is not radical reform versus moderation. The Coburn/Ryan bill is just as radical as ObamaCare, maybe more so. During the election, John McCain’s health plan was more radical than Barack Obama’s.

No, there are two differences — neither of which was explained at the Summit.

First, the House and Senate bills and the Obama merger of those two are really bad bills. The best kept secret in Washington (at least it’s never mentioned by the press corps) is that every special interest group that has signed on to this reform privately hopes it will fail. Everybody who knows anything about health care knows that the end result will be bad for the country.

Second, as I explained in a previous blog entry, the two parties are actually miles apart. Coburn and Ryan want to give every family the same subsidy and let them have almost unrestricted choice of benefit packages. The Democrats want everybody to ...

The difference between Republicans and Democrats is not radical reform versus moderation. The Coburn/Ryan bill is just as radical as ObamaCare, maybe more so. During the election, John McCain’s health plan was more radical than Barack Obama’s.

No, there are two differences — neither of which was explained at the Summit.

First, the House and Senate bills and the Obama merger of those two are really bad bills. The best kept secret in Washington (at least it’s never mentioned by the press corps) is that every special interest group that has signed on to this reform privately hopes it will fail. Everybody who knows anything about health care knows that the end result will be bad for the country.

Second, as I explained in a previous blog entry, the two parties are actually miles apart. Coburn and Ryan want to give every family the same subsidy and let them have almost unrestricted choice of benefit packages. The Democrats want everybody to have the same benefit package, but propose wildly different subsidies (more than $10,000 for a family at the same income level!), depending on whether people get insurance at work or in an exchange.

March 1, 2010 8:21 AM

Americans Confused

James Madison Professor of Political Economy, Professor of Economics and Public Affairs

House of Representative Minority Leader John Boehner, R-Ohio, said: "The thing I have heard more than anything over the last six or seven months is that the American people want us to scrap this bill. They have said it loud. They have said it clear."

I suspect he is right.

Of course, that leaves open two questions: (1) Do the American people actually have a good grasp what is in the bills passed by the Democrats and what would happen to them if health reform failed and (2) are the wishes of the American people actually mutually consistent, in the sense that they could be accommodated in a coherent health-reform bill?

As to the first question, I recall Humphrey Taylor of the Lou-Harris Group telling me that in a survey taken during in the 1990s a majority of respondents expressed approval of the main components of the Clinton health-reform plan, when they were not told that these were the chief components of the Clinton plan. When, at the end of the interview, respondents were asked whether they were familiar with the Clinton plan and, if so, what...

House of Representative Minority Leader John Boehner, R-Ohio, said: "The thing I have heard more than anything over the last six or seven months is that the American people want us to scrap this bill. They have said it loud. They have said it clear."

I suspect he is right.

Of course, that leaves open two questions: (1) Do the American people actually have a good grasp what is in the bills passed by the Democrats and what would happen to them if health reform failed and (2) are the wishes of the American people actually mutually consistent, in the sense that they could be accommodated in a coherent health-reform bill?

As to the first question, I recall Humphrey Taylor of the Lou-Harris Group telling me that in a survey taken during in the 1990s a majority of respondents expressed approval of the main components of the Clinton health-reform plan, when they were not told that these were the chief components of the Clinton plan. When, at the end of the interview, respondents were asked whether they were familiar with the Clinton plan and, if so, what they thought of it, a majority expressed vehement opposition to it.

To illustrate, many Americans believe that it would unconstitutional to be mandated to have health insurance for at least catastrophic illness. On the other hand, they also believe that they have an inherent right to critically needed health care when they fall seriously ill or have serious accidents, even if they then cannot pay for that care with their own resources. To call that an “adolescent” perspective would be unfair to adolescents.

Similarly, many Americans seem to believe in their right to practice adverse risk selection against health insurance companies – to free-load, in plainer English. By that I mean that they want the premiums that insurers charge them to be independent of their personal health status, but they to not want to be mandated to buy health insurance when they are healthy. The inevitable result, observable in states that have such arrangements, is that healthy people refuse to buy insurance until they fall seriously ill, which they can then purchase insurance at premiums that are divorced from their health status. That attitude, too, is so immature that even a teenager would blanch at it.

It would be interesting to see what kind of health reform the American people actually would accept. If the President had seriously embraced the Wyden-Bennett bill, which economists find appealing, there would have been a howl at the idea that employers would no longer be the kindly social workers for their employees and that employees would be on their own, having to choose insurance in the open market without the guidance of the employee-benefit department. If the President had embraced Senator Coburn’s bill, the U.S. Chamber of Commerce, the National Association of Manufacturers and the unions would be likely to form an unholy alliance to foment opposition to taxing employer paid health insurance premiums.

A bill that probably could pass today would be something like the Medicare Modernization Act of 2003 (MMA 03), pushed through the Congress by President Bush in late 2003. The Act gave the elderly a huge new permanent entitlement and was not tax financed, a feature Americans like. Instead, the cost of the MMA ‘03 since its inception has simply been added to the federal deficit and financed by selling newly printed Treasury bonds, many of them sold to China and Japan. Our children and grandchildren will have to pay back these loans with higher taxes or fewer federal benefits but, as the French Sun King Louix IV so nicely put it “Apres moi, le deluge!” (After me, let the flood come!). The MMA ‘03 alone will add close to $1.2 trillion to the federal deficit over 2010-19.

Contemporary Americans seem to like that sort of thing – a new entitlement left for our children and grandchildren to pay. House Leader Boehner, by the way, evidently liked it, too. He voted for it in 2003 (http://clerk.house.gov/evs/2003/roll332.xml), along with 206 of his Republican colleagues in the House.

So perhaps something like the MMA ‘03 might hold some hope for passage: some new entitlement to please the American voter today, but put on the tab for our grand children to pay. It can be doubted that the American people will sit still for anything that will raise taxes or cuts their favored federal subsidies. For example, would the farm states, which are disproportionately represented on Capitol Hill, ever sit still for having their welfare payments (otherwise known as “agricultural subsidies”) cut?

February 26, 2010 12:06 PM

Major Point of Agreement on Reform

Most participants appeared to agree on the need for insurance reform. Many Americans fear that they could contract a long expensive illness and ultimately be unable to find coverage once their employer coverage terminates. The public also wants to know that plans will not rescind coverage once they become ill and that the plan will pay for necessary treatments. Addressing these fears may be more important to voters than covering the uninsured.

While many participants agreed on these points, they differ widely on how to achieve them. The Democrats require all Americans to have health insurance, which broadens the risk pool enough that the government can require guaranteed issue of insurance without driving up premiums for those who are already purchasing coverage. But, it requires a mandate and $850 billion to help those who can not afford it.

The Republican high-risk pool proposal would assure coverage is available to people who are denied coverage due to health status. The premium in the pool would be about 50 percent greater than what an average individual woul...

Most participants appeared to agree on the need for insurance reform. Many Americans fear that they could contract a long expensive illness and ultimately be unable to find coverage once their employer coverage terminates. The public also wants to know that plans will not rescind coverage once they become ill and that the plan will pay for necessary treatments. Addressing these fears may be more important to voters than covering the uninsured.

While many participants agreed on these points, they differ widely on how to achieve them. The Democrats require all Americans to have health insurance, which broadens the risk pool enough that the government can require guaranteed issue of insurance without driving up premiums for those who are already purchasing coverage. But, it requires a mandate and $850 billion to help those who can not afford it.

The Republican high-risk pool proposal would assure coverage is available to people who are denied coverage due to health status. The premium in the pool would be about 50 percent greater than what an average individual would pay for coverage, but is substantially less than expected costs for this group. Thus, the high risk pools would require funding to cover losses, although much less than the cost of subsidies under the Senate and House bill. While this does little to help low-income people, it does address those middle-class fears of losing everything even though they have dutifully maintained coverage throughout their lives.

February 26, 2010 9:57 AM

Bipartisan Ideas Already In Bills

We owe it to the American people to let facts – not rhetoric – define this discussion. I’m glad that we could come together to sit down and talk about the facts. The facts I heard today indicate that we have so many areas of agreement and many of these bipartisan ideas are already in our bill. Republicans and Democrats agree we should focus on prevention. We agree we should give individuals and small businesses a new marketplace where they can pool together to get lower rates. We agree we should aggressively fight fraud, waste and abuse. These are just some of the many areas where we agree.

I was pleased that our focus today was making our health care system more affordable and more sustainable. Too many families and too many small businesses are struggling under our broken system. For these hard-working families and small businesses, it is clear that we must pass health reform. And we must pass it this year.

February 26, 2010 9:53 AM

Individual Mandate Unconstitutional

During this afternoon’s health care summit at the White House, House Republican Leader John Boehner (R-OH) told President Obama directly that the “individual mandate” included in the Democratic health care legislation being ushered through Congress is unconstitutional.

“It’s not just the taxes or the Medicare cuts. You’ve got the individual mandate here, which I think is unwise and I do believe is unconstitutional,” Boehner told President Obama.

Boehner’s remark drew a sharp response from the president, who suggested the Republican leader was resorting to “talking points” instead of engaging in a productive bipartisan dialogue. But Boehner is hardly alone in his belief that the president’s legislation is unconstitutional, and it isn’t just Republicans who have raised the issue. State lawmakers in at least 36 states have introduced legislation in their state legislatures to declaring their states’ freedom from ObamaCare’s unconstitutional individual mandate. Banding t...

During this afternoon’s health care summit at the White House, House Republican Leader John Boehner (R-OH) told President Obama directly that the “individual mandate” included in the Democratic health care legislation being ushered through Congress is unconstitutional.

“It’s not just the taxes or the Medicare cuts. You’ve got the individual mandate here, which I think is unwise and I do believe is unconstitutional,” Boehner told President Obama.

Boehner’s remark drew a sharp response from the president, who suggested the Republican leader was resorting to “talking points” instead of engaging in a productive bipartisan dialogue. But Boehner is hardly alone in his belief that the president’s legislation is unconstitutional, and it isn’t just Republicans who have raised the issue. State lawmakers in at least 36 states have introduced legislation in their state legislatures to declaring their states’ freedom from ObamaCare’s unconstitutional individual mandate. Banding together through the nonpartisan American Legislative Exchange Council (ALEC), many of these lawmakers sent a letter to President Obama earlier this week expressing their disapproval of the White House decision to exclude governors and state legislators from the health care summit.

“We know that any federal health care legislation will eventually rely on the states to implement, manage, and fund the reform effort,” the state legislators wrote. “Many state legislators, like us, are also concerned about the effects that a proposed individual or employer mandate will have on our citizens and small businesses. We are disappointed that state legislators have not been involved in this effort and that you would not include state legislators in [the Feb. 25] meeting.”

In Congress, Boehner and Rep. Devin Nunes (R-CA) have been urging colleagues to get involved with the state-level revolt brewing against ObamaCare. Boehner, Nunes, and Rep. Mike Rogers (R-MI) last year launched the GOP State Solutions project, an initiative aimed at improving legislative coordination between reform-minded House Republicans and governors and state legislators outside the Beltway.

Boehner says the White House’s exclusion of state legislators is disappointing, but certainly in keeping with the Obama Administration’s Washington-knows-best mentality:

“It is greatly disappointing that state legislators haven’t been given a role in this summit, despite the fact that legislation opting out of a federal takeover of health care has been introduced in at least 36 states. Limiting participation in this summit to Obama Administration officials and congressional leaders shuts out state lawmakers who can help illustrate the damage this massive federal takeover of health care would do to states. The White House may be in denial about the revolt going on in the states against this costly, job-killing monstrosity, but it’s real and it’s gaining momentum by the day.”

A September 2009 article in the New York Times documented state efforts to opt-out of ObamaCare’s unconstitutional individual mandate.

“[A] small but growing group of lawmakers is pressing for state constitutional amendments that would outlaw a crucial element of the health care plans under discussion in Washington: the requirement that nearly everyone buy insurance or pay a penalty,” the article noted. At the time the article was written, about a dozen states had introduced such resolutions. As of February 2010, such measures have been introduced in a total of 36 states.

Obama Allows Taxpayer-Funded Abortions

At today’s White House “summit,” House Republican Leader Boehner noted that, for the first time in 30 years, both the Senate health care bill and the President’s “new” proposal will allow taxpayer funding of abortion. Boehner said:

"Let me just make one other point. For 30 years, we’ve had a federal law that says that we’re not going to have taxpayer funding of abortions. We have had this debate in the House. It was a very serious debate. But in the House, the House spoke. The House upheld the language we have had in law for 30 years that there will be no taxpayer funding of abortions. This bill that we have before us, and there was no reference to the issue in your outline, Mr. Presiden...

At today’s White House “summit,” House Republican Leader Boehner noted that, for the first time in 30 years, both the Senate health care bill and the President’s “new” proposal will allow taxpayer funding of abortion. Boehner said:

"Let me just make one other point. For 30 years, we’ve had a federal law that says that we’re not going to have taxpayer funding of abortions. We have had this debate in the House. It was a very serious debate. But in the House, the House spoke. The House upheld the language we have had in law for 30 years that there will be no taxpayer funding of abortions. This bill that we have before us, and there was no reference to the issue in your outline, Mr. President, begins for the first time in 30 years allows the taxpayer funding of abortion."

Speaker Nancy Pelosi (D-CA) responded and claimed this isn’t true, but the American people disagree, as do a bipartisan majority in the House of Representatives - most notably Rep. Bart Stupak (D-MI), who called the President’s proposal “unacceptable.”

Here are the facts: President Obama’s “new” health care proposal would still levy a new “abortion premium” fee and use government funds to subsidize elective abortion. Just like Senate Majority Leader Harry Reid’s (D-NV) 2,074-page health care “manager’s amendment,” that passed the Senate in December, and just like the original 2,032-page, government-run health care plan from Speaker Nancy Pelosi’s (D-CA), the President’s “new” proposal levies an abortion premium and does not fix the problem of government funds being used to subsidize elective abortions.

Under the President’s proposal - released Monday and modeled after Senator Reid’s plan that passed the Senate, according to ABC News - there is no prohibition on abortion coverage in federally subsidized plans participating in the Exchange. Instead the proposal includes layers of accounting gimmicks that demand that plans participating in the Exchange or the new government-run plan that will be managed by the Office of Personnel Management must establish “allocation accounts” when elective abortion is a covered benefit (p. 2073-2074). Everyone enrolled in these plans must pay a monthly abortion premium (p. 2072, lines 18-21), and these funds will be used to pay for the elective abortion services. The Obama proposal directs insurance companies to assess the cost of elective abortion coverage (p. 2074-2075), and charge a minimum of $1 per enrollee per month (p. 2075, lines 8-10).

In short, the President’s proposal continues to defy the will of the American people and contradict longstanding federal policy by providing federal subsidies to private health plans that cover elective abortions. The proposal does include a “state opt-out” provision if a state passes a law to prohibit insurance coverage of abortion, but it’s a sham because it does nothing to prevent one state’s tax dollars from paying for elective abortions in other states.

A majority of Americans believe that health care plans should not be mandated to provide elective abortion coverage, and a majority of Americans do not believe government health care plans should include abortion coverage. Currently, federal appropriations bills include language known as the Hyde Amendment that prohibits the use of federal funds to pay for elective abortions under the Medicare and Medicaid programs, while another provision, known as the Smith Amendment, prohibits federal funding of abortion under the federal employees’ health benefits plan. Under the President’s proposal the new health care plan that will mirror the federal employees’ plan and be managed by the Office of Personnel Management will NOT be subject to the Smith Amendment.

President Obama’s health care proposal is an affront to the American people and drastically moves away from current policy. The American people deserve more from their government than being forced to pay for abortion. The pro-life Stupak/Pitts amendment passed the House by a vote of 240 to 194, enjoying the overwhelming support of 176 Republicans and 64 Democrats. The Stupak/Pitts Amendment codifies current law by prohibiting federal funding of elective abortions under any government-run plan or plans available under the Exchange. The President’s plan ignores the will of a bipartisan majority of the House, and indeed the American people.

Health care reform should not be used as an opportunity to use federal funds to pay for elective abortions. Health reform should be an opportunity to protect human life - not end it - and the American people agree. House Republicans have offered a common-sense, responsible solution that would reduce health care costs and expand access while protecting the dignity of all human life. The Republican plan, available at HealthCare.GOP.gov, would codify the Hyde Amendment and prohibit all authorized and appropriated federal funds from being used to pay for abortion. And under the Republican plan, any health plan that includes abortion coverage may not receive federal funds.

February 26, 2010 9:26 AM

If we learned one thing from today's summit, it's that the Republicans have learned nothing.

For the past year - and indeed, years before that - there has been a national dialogue about our failed health system and the need for serious, meaningful reform that guarantees insurance companies no longer stand between the American public and the care we need.

Hundreds of citizens marched into Washington yesterday on behalf of Melanie Shouse, a 41-year old health reform activist who died earlier this month after a long, painful battle with her health insurance company over coverage for the chemotherapy she desperately needed.

Their message - and the lesson we all should have learned over this past year - is that health insurance reform cannot wait.

During the Summit, 4,083 more people lost their health insurance. Another 708 filed bankruptcy because of their medical bills. And, thirty five died because they could not afford care.

By continuing to ignore the reality facing families across our country, the Republicans remain the party of no – abandoning bipartisan ideas and choosing to obstruct in the hope of political gain in the next election.

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